Although the length of the penis is the most discussed issue related to male organ enhancement, the interest in surgical procedures that enable penis thickening is growing. While the importance of enhancement surgery on the micro- and macrostructure of the penis lies mainly in psychological and social factors, there are also significant semantic functions related to names and medical terminology in this area. Due to the increasing interest in penis thickening, a comprehensive comparison of best penile girth enhancement methods seems fully justified. The first reports on penis thickening surgery in the literature referred to dermal fat grafting. The first report mainly concerns lipostructure as well as AlloDerm. The purpose of penis thickening surgery techniques is to restore, in accordance with aesthetic standards, the linear non-deviation of the penis, the hypertrophy of the bulbospongiosus muscle, the vestibule, and the meatus, in order to increase the girth of the free portion of the penis, also increasing the shortened corpora cavernosa, corporeal body, and corpora spongiosa by expanding them intraoperatively. Penile thickening may be requested by patients who have a normal-sized penis, but not one which they feel is large enough for their body and self-esteem. Candidates must be adults and emotionally stable after a thorough psychological assessment. They should carefully recount their emotional and sexual experiences related to body image. Ethical aspects: obtaining written informed consent is mandatory after carefully explaining different surgical procedures and expected surgical outcomes. The principle of shared information is fundamental, along with informing patients of all aspects, speculating outcomes, possible complications, imperfect results of the anatomy, and improvement of some elements of anatomy, together with the ability to manage non-cognitive expectations that are shaped by the surgeon.
Various techniques for augmenting penile girth have been described until now, and they can be divided into two groups according to the material used to enhance the shaft circumference. In the first group, the method consists of autologous tissue transplant, while the second is based on alloplastic implants. The first one is by far the largest and can be further divided into sub-groups based on the adopted material. The best penile girth enhancement methods to be discussed in this chapter include the most frequently used and reported: fat injection and dermal grafting. These penis thickening surgery techniques share some similarities in the way they act and the results they can achieve, but they also have some differences, which will be highlighted. Finally, the chapter will provide a proposal about how to choose the most appropriate technique according to patient anatomic features and requests.
For a long time, fat was the most frequent filler material used for penis girth augmentation. The introduction of the suction-assisted lipoplasty technique resulted in a considerable increase in the availability of autogenous fat. This new approach to adipose tissue was rapidly reflected in the surgical field and allowed for a considerable number of tissue transplant procedures. Over the years, a new surgical approach was developed, consisting of a graft of autologous dermis obtained from the forehead scalp instead of fascia lata. In particular, a modified technique involved creating a defect in the deep Buck’s fascia, below the edge of the pubic bone, and filling it with decapsulated dermis from three artificial dermis strips. Comparative data about dermal grafting and fat injection do not exist; however, there is a report of a more regular shape filling and easier handling for dermal grafting than for fat injection. The dermal strip was incised, and the graft was spread over the opposite dermal surface before introducing it into the superficial foreskin after the degloving of the penile shaft over the prevesical space. It was composed of autologous dermis, preprocessed and taken from the anterior part of the hairy scalp, managed before an average time of thirty days in the operating room. The length was 140 mm (range 130–155 mm), the width was 50 mm (range 40–55 mm), and the thickness was 0.15 mm. This method was applied to nine males, and a few complications and a good cosmetic result were reported. One of them showed a penile abscess, an infection, and hematoma in one case, and penile deviation in another case. In all the cases, the genitalia showed a good cosmetic result, and patient satisfaction was considered to be excellent. Through questionnaires, the patients and their partners reported an average increase in the erect penile circumference at the base of 3.4 cm (range 2.8–4.4 cm) and 5.6 cm (range 4.3–6.6 cm) at the mid-shaft. All the patients were satisfied with the results. Furthermore, individual cases of dermal grafting with maxillofacial dermis or silicone sheets were noted. Provided the results obtained in decreasing the subjective perception of penile length and height, there was a suggestion of a possible positive effect of this system on glandular size.
We reviewed seven articles and an internet survey comparing penile thickening procedures for penile size enhancement. In terms of patient satisfaction rate, the number of complications, and the follow-up period, the best penile girth enhancement methods were analyzed. We systematize the criteria for the comparison of the penis thickening surgery techniques and compare them on the basis of clinical data. The measurements are the patient satisfaction rate, the available data on permanent complications rate, durability of the surgery, and, as the most important outcome parameter, we link the duration of postoperative recovery time and the minimal time interval for penile re-intervention required because of newer developments. A total of eight studies on penile thickening surgery were reviewed.
Patient satisfaction is considered very useful in understanding the comparison of the different techniques. Tissue migration is less likely after autologous fat injection techniques in postoperative wound healing. Filler-based techniques are less invasive and have excellent patient satisfaction rates. Short-term effective penis surgery techniques are also easier to manage and reverse but typically only last a limited time. When considering tissue-engineering techniques, it is important to understand that different patient demographics might determine sometimes opposing objectives of organ reconstruction. In the case of personalized constructs, both demographics and the range of autonomics and stretch available of the native corpus cavernosum must be considered, and patients should be provided with the best information about the procedure chosen while presenting them with both the advantages and limitations of their personal choice.
In comparing the three penis thickening surgery techniques, the cost of the fee for the tunica albuginea dissection was less, and the procedure time was less than that for the autologous tissue dissection. The penis thickening surgery cost of the fat invention was around more, and the estimated anesthesia fees and surgery center costs were comparable for the three autologous techniques. The procedure time was the longest for the cicatrix dissection, at a mean of minutes. Penile prosthesis with the ABI has a mean surgeon fee that is more than the bulbourethral sling. With physician charges included, the surgical procedure time for the penile prosthesis with the AdVance XP and AdVance XP Magnum is a lot shorter compared to the duplicate surgery.
Financially viable is a broad concept that depends on various other influencing factors. The costs discussed above are the sums that are generally paid directly to the medical provider. For a fee-based surgical center, they include the entire bundled operating and recovery room fee. In some cases, a larger onboard processing fee is also presented in the penis thickening surgery cost. To some men, especially those who are not impotent, the penis thickening surgery cost comes potentially before the treatment itself. One must consider whether or not treatment options are financially viable at the given time before considering the feasibility of treatment based on the price. Additionally, men should consider whether the expected effective penis surgery techniques of the treatment is worth the investment. Are you going to experience this treatment on a mental, personal, or sexual level that justifies the investment? If you are not feeling normal due to penile thickening, would penis thickening surgery cost? Treatment choice will depend on where a man is financially and emotionally. There is no right or wrong answer; it is a matter for an individual man to discuss with his urologist.
Increasing numbers of patients aim for penis thickening surgery, and autonomous efforts to answer their needs are on the rise. Penis thickening surgery may result in perioperative and postoperative complications; this should be remembered when deciding on proceeding with the surgery and choosing the type of intervention. Considering the pros, cons, and complications of penile fillers, it can be the right option for properly selected patients who consciously make this decision. Otherwise, there are many questions, especially for the patient who chooses the surgical intervention more autonomously and expects optimization of this method.
Recent advancements are of great clinical interest and have further potential for improvement in surgical techniques and the use of newer fillers and/or materials in the penis. More research on this topic is needed, especially on patients undergoing penis thickening surgery and psychosexual aspects. It remains problematic to say anything definitive. This direction should also be considered in future studies. Even positive data on the anti-permeant fillers available can change the attitude of some surgeons towards the event index. Another field that deserves systematic scientific discussion for the use of intermolecular materials is the influence of psychiatric disorders and cooperating drugs. To be safe, information should be included to reduce the number of patients with various psychiatric dysfunctions. Finally, the evaluation of penis thickening surgery becomes predictable and global.
